title: The duration of symptoms predicts the presence of malignancy in 210 resected cases of pancreatic intraductal papillary mucinous neoplasms.
abstract: BACKGROUND
  Using Kaplan-Meier curves, a 2006 study illustrated a shorter time interval between development of symptoms and detection of malignant IPMN in the main pancreatic duct versus a side-branch duct location. Of 93 cases, only 62 were confirmed histologically. To support these interesting findings, we examined a larger cohort of cases where the diagnosis was confirmed histologically and asked if symptoms by themselves, as well as main duct location, were associated with malignant detection.
  
  
  METHODS
  Between 1989 and 2009, 210 IPMN cases meeting international criteria were resected and histologically examined. Actuarial rates of malignant detection over time were calculated from the first clinical symptom to malignant detection (resection). These rates of malignant detection over time were compared for main vs. side-branch duct location and symptomatic vs. asymptomatic cases.
  
  
  RESULTS
  The most common indications for resection were symptoms (88%) and main pancreatic duct location (65%). The actuarial malignant detection rates were significantly shorter for main duct location and also for symptomatic cases, regardless of duct location.
  
  
  CONCLUSIONS
  Presence of symptoms followed by main pancreatic duct location had a significantly shorter elapsed time to malignant detection. The visual depiction of these actuarial rates highlights the importance of the clinical history. To determine malignant risk, the primary determinants for resection were either symptoms or main duct location (but not cyst size), confirming the 2006 study with a larger cohort of histologically confirmed cases.
authors.affiliation: Department of General Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Moriya
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: L William
authors.initials: LW
authors.lastname: Traverso
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology*; D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000453:epidemiology*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D014768:Virginia / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology